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Radhakrishnan NS, Lukose K, Cartwright R, Sleiman A, Matey N, Lim D, LeGault T, Pollard S, Gravina N, Southwick FS. Prospective application of the interdisciplinary bedside rounding checklist 'TEMP' is associated with reduced infections and length of hospital stay. BMJ Open Qual 2022; 11:bmjoq-2022-002045. [PMID: 36588303 PMCID: PMC9723909 DOI: 10.1136/bmjoq-2022-002045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/05/2022] [Indexed: 12/09/2022] Open
Abstract
Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%-11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care.
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Affiliation(s)
- Nila S Radhakrishnan
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Lukose
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Richard Cartwright
- Office of Clinical Quality and Patient Safety, University of Florida Health, Gainesville, Florida, USA
| | - Andressa Sleiman
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Nicholas Matey
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Duke Lim
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Tiffany LeGault
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Sapheria Pollard
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Frederick S Southwick
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Gravina N, Sleiman A, Southwick FS, Matey N, Harlan E, Lukose K, Hack G, Radhakrishnan NS. Increasing adherence to a standardized rounding procedure in two hospital in-patient units. J Appl Behav Anal 2021; 54:1514-1525. [PMID: 34289103 DOI: 10.1002/jaba.865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/06/2022]
Abstract
Standardized bedside rounds can improve communication and the quality of care for patients in hospitals. However, it can be challenging to change previously established provider practices to adhere to new procedures. This study evaluated 2 packaged interventions, derived from a modified Performance Diagnostic Checklist interview, to increase adherence to standardized rounding practices in 2 hospital units. Researchers observed physicians at a university hospital on rounds 2-3 times per week, and 2 phases of intervention were implemented to improve adherence. The interventions included task clarification, feedback, and weekly huddles. Compared to baseline, phases 1 and 2 of the intervention improved clinician adherence to the standardized bedside rounding checklist by 24.94% and 30.94% in unit 1 and 26.76% and 44.06% in unit 2, respectively. The standardized rounds did not require additional time following the intervention. These results indicate that physician adherence can be improved through behavioral interventions.
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Affiliation(s)
| | | | | | | | | | | | - Garret Hack
- Department of Psychology at University of Florida
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Matey N, Sleiman A, Nastasi J, Richard E, Gravina N. Varying reactions to feedback and their effects on observer accuracy and feedback omission. J Appl Behav Anal 2021; 54:1188-1198. [PMID: 33856045 DOI: 10.1002/jaba.840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/06/2022]
Abstract
The effectiveness of performance feedback depends on many factors, including accuracy and repeated delivery over time. Previous research has suggested that requiring the delivery of performance feedback may result in less accurate observations and feedback during subsequent observations. The current study evaluated whether different reactions (i.e., positive, neutral, or negative) to feedback would affect the accuracy of subsequent observations or the delivery of feedback. Forty-five participants were assigned to 1 of 3 reactions groups and they were instructed to observe and record the safety performance of a confederate during a baseline condition. Following 2 baseline sessions, participants were instructed to deliver feedback and the confederate reacted to the feedback according to the assigned condition for 4 sessions. Results provide evidence that positive reactions maintain observation accuracy and the provision of feedback, while both neutral and negative reactions decrease observation accuracy and result in frequent omission of feedback.
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Affiliation(s)
| | | | | | - Erin Richard
- School of Leadership and Human Resources Development, Louisiana State University
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Matey N, Gravina N, Davis B, George R, Rosbrook T. Increasing Productivity in a Manufacturing Setting using Daily Process Walks. Journal of Organizational Behavior Management 2021. [DOI: 10.1080/01608061.2021.1897058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nicholas Matey
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, Florida, USA
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Gravina N, Nastasi JA, Sleiman AA, Matey N, Simmons DE. Behavioral strategies for reducing disease transmission in the workplace. J Appl Behav Anal 2020; 53:1935-1954. [PMID: 33063854 DOI: 10.1002/jaba.779] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 12/26/2022]
Abstract
The coronavirus pandemic highlighted that workplaces may serve as a hub of disease transmission if proper precautions are not enacted. The Centers for Disease Control recommends several strategies for decreasing the spread of illnesses in the workplace, including a) promoting proper hand hygiene, b) cleaning and sanitizing the work area, c) encouraging sick employees to stay home, d) personal protective equipment, and, e) social distancing. Research suggests that instructions are often not sufficient to change work behaviors, and behavioral interventions may be needed. Thus, the present paper reviews existing research that informs the implementation of behavioral strategies to reduce the spread of disease in the workplace, and makes recommendations for organizations to protect employees, clients, and customers. Intervention components such as training, prompts, the reduction of response effort, clear workplace policies, feedback, and consequences are discussed, and practical recommendations and suggestions for future research are provided.
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Sleiman AA, Matey N, Gravina NE. Ranking of the Most Prolific Authors, Universities, and Organizations in the Journal of Organizational Behavior Management. Journal of Organizational Behavior Management 2020. [DOI: 10.1080/01608061.2020.1746726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gravina N, Sleiman A, Matey N. Participation of Women in the Journal of Organizational Behavior Management: An Update and Extension. Journal of Organizational Behavior Management 2019. [DOI: 10.1080/01608061.2019.1666778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Griffin M, Gravina NE, Matey N, Pritchard J, Wine B. Using Scorecards and a Lottery to Improve the Performance of Behavior Technicians in Two Autism Treatment Clinics. Journal of Organizational Behavior Management 2019. [DOI: 10.1080/01608061.2019.1632241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Nicole E. Gravina
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Nicholas Matey
- Department of Psychology, University of Florida, Gainesville, FL, USA
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